Wednesday, April 1, 2009

Today, the evidence of risk of intervention in private vs. public is very sad. In public hospitals, the c-section rate is around 28% on average. In some private hospitals in Australia, the c-section rate is climbing part 60%. The World Health Organisation recommends a c-section rate of 10% to be a healthy number. (Here, a recent article in the Sydney Morning Herald delves more into statistics and reasons why the rates are getting so high.)

Below, I have written an article to help inform women of their choices, the difference between those choices and the importance of choosing your care provider carefully:

Where will you have your baby? Who will offer you support? Public or private? And the choices go on... Planning your birth is not just about having a birth plan, and here's why.

The choices you make during pregnancy will more than likely have a direct impact on what kind of birth experience you have, therefore largely determining how at ease you feel with caring for your baby after the birth.

Often the first major decision that needs to be made is where to give birth to your baby. Women can tend to feel rushed into determining where they will give birth and booking in (if a hospital / birth centre is chosen). But approach with caution, as you'll see that where you decide to have your baby and who supports you during this time could very well be the most important decision you will make regarding the birth of your baby. This is because the model of care that you choose in pregnancy can hold the consequence of limiting your options and choices during your labour and birth.

Consider your beliefs about birth. Does your chosen model of care uphold the same beliefs?Consider what type of birth you desire. Is this type of birth encouraged or even possible with the model of care you have chosen? In other words, how likely is it that you will achieve this type of birth under this model of care?

Consider your definition of a safe birth for you and your baby. What are the statistics for the model of care you have chosen? Do you believe you can achieve your definition of a safe birth under the model of care you have chosen?

Consider who should be at the centre of your birth experience. Is the model of care you have chosen woman-centred, doctor-centred or perhaps protocol-centred?

Consider how much input you should have in your birth experience. Does your care provider practice active management (completing procedures before they are required, "just in case") or expectant management (wait and see how you and your baby handle it, then intervene only if medically necessary)?

Consider when you feel interventions may become necessary. Does your care provider practice any routine procedures or interventions? Do they practice evidence-based care (when there is evidence to prove that an intervention, under certain circumstances, is safer than not intervening at all)? How do you feel about interventions and are you comfortable with your care provider's policy on interventions?

As mentioned above, planning your birth is more than having a birth plan. But birth plans are probably the best way for you to inform your birth team about what you would definitely like to see happen, what you would definitely like to avoid and what you are open to. Make your birth plan easy to read and to the point. Include in your birth plan your decisions about support people, the environment, interventions, monitoring, who's catching your baby, who's cutting the cord, when to cut the cord and where you would like your baby straight after birth. Have your care provider keep a copy of your birth plan on file to check back on so that you only have to discuss a minimal amount whilst you are in labour.

Now that you have thought more about your model of care and your birth plan, the time has come for you to be conscious of the fact that your lifestyle during pregnancy can directly affect the experience you have during the birth of your baby. It is wise to make positive lifestyle choices during this time, including good nutrition, exercising well and getting enough rest. You might also benefit from preparing yourself physically for your baby's birth, practising positions you would like to use (e.g. squatting or lunging) .

Towards the end of your pregnancy, it is a good idea to be thinking about encouraging your baby to be lying in the easiest way possible to be born. Avoiding postures where you are slouching/lying on your back and making sure you spend some time each day in the "crawling position" will encourage your baby's spine to swing to the front of your tummy. This means your baby's face will be towards your spine, which is the optimal position for your baby to be born. You can find out more about this by researching "optimal fetal positioning".

Take the time during pregnancy to practise your relaxation techniques, including using breathing and meditation to relax your body and mind. These will come in handy later on; many women find that these techniques assist the most in helping them through the discomfort of labour.

Pregnancy is a time to inform yourself about your options and make choices that are right for you. Approach the birth of your baby with an open, positive mind and think of labour as being only one contraction at a time, with a beautiful prize and well-earned rest afterwards.

Remember, your body has been beautifully and wonderfully made and you CAN achieve the birth you desire!

Wednesday, March 11, 2009

Here is an article I wrote to empower pregnant women, and to help teach them that their bodies are made perfectly with the ability to birth their baby, just how nature intended. Enjoy!

Did you know that you have been wonderfully made, with all the perfect equipment and tools required to birth your baby just the way you would like to?

Your uterus has three layers of strong muscle, made especially to birth your baby. The outer muscle layer has longitudinal fibres that allow the baby to descend by retracting. The middle layer is made of criss-cross fibres that provide the other two layers with the blood they need to work. The inner layer is made of ringed fibres that wrap around the uterus and the cervix and expel the baby by contracting.

Did you know that the blood in your body goes to where it is most needed? It is important during labour for you to relax, so that the uterus is getting as much blood as possible. If you are not relaxed your body will send more blood than is required to your extremities ready for what it predicts will happen – a ‘flight or fight’ response – and your uterus will not be able to work as efficiently. Good practices of relaxation include meditation, visualisation and positive affirmations.

Did you know that when you breathe slowly and deeply you provide your body with as much oxygen as possible? This is important during labour as the more oxygenated the blood is that goes to the uterus, the more effective it will be at birthing your baby. It is a good idea to practice breathing long, slow breaths. This can be incorporated with your relaxation routine to be used during labour.

Did you know that if you are afraid of labour being painful, it is more likely that you will actually experience pain? This is due to the “fear, tension, pain” cycle. When you experience fear, your body produces chemicals that change the way your body works, that in turn triggers the ‘flight or fight’ mechanism. This causes your uterus to continue working with less oxygen, the body tries to stop labour (thinking there is danger), and the muscles begin to work out of sequence, which causes unnecessary pain. It is important that you deal with any fears about the impending birth while you are pregnant to prevent them from having a negative affect on your labour. Relaxation and meditation can help with these.

Did you know that when you are praised and loved it can make a labour shorter, easier and happier? This is because when you feel good, a powerful hormone called oxytocin (the love hormone) is being released into your body. Oxytocin is a potent stimulator of contractions, and helps to dilate the cervix and move the baby down and out of your body. Your body will produce oxytocin to help birth your baby when you are relaxed, when your partner speaks positive words and gives you hugs, when you are comfortable and when you trust in your body and those around you.

Did you know you can help your body birth your baby by having an active labour? This does not necessarily mean continually moving around, but putting your body into positions which encourage the descent of the baby. You can use gravity to help expel your baby and you can use positions that encourage your pelvis to open and allow the baby to move through easier.

So, birthing your baby will be made much easier if you firstly surrender to your body – it knows what to do. Prepare yourself while you are pregnant to help you relax as much as possible during labour, clarify anything you are unsure about beforehand, surround yourself with people who speak positively about the impending birth and talk to your partner and your baby about the feelings you are experiencing. When the day comes, try to remain as calm as possible and focus on the practise you’ve done to prepare yourself for a beautiful labour experience!

Sunday, March 1, 2009

When I say "The Language of Birth" I don't mean all those clinical terms your birth team use (usually between each other, that you may or may not understand); I'm referring to the way you are spoken to, about or on behalf of during the labour and birth of your baby.

Imagine you had been labouring for a long time. You are tired. You are feeling weak. You may even be questioning whether you can actually do it! You arrive at the hospital. The 'medical person' asks if you'd like her to check how dilated you are. You consent. She or he does the V.E. (vaginal examination) and finds out you are 3cm. In the realm of language, it can be said one of two ways:

"Oh, you're only 3cm. You've really only started labour. If you haven't had the baby in another X amount of hours, we'll have to think about augmentation (speeding up labour) [which means you'll need to be strapped to a monitor and your movement will be limited, and there's also a much higher need for pain relief as chemical contractions can be much more intense than 'natural' contractions]." You are being restricted in your abilities already. Is there any need for implying that you don't have a choice as to what happens next if your body doesn't birth your baby in a certain time? This language may be considered quite threatening and you might start to feel as though you can't trust this person.

"Wow! You're 3cm. You've done such a good job to get to this point at home. Some people consider the most difficult part of first stage labour is 0-3cm. Keep doing what you're doing and if you need more support just let me know." You are been given a lot more freedom and probably feeling much more positive about how far you've come.

The language of birth can be so vastly different, and in the same way drive vastly different outcomes. When thinking about what to say during labour to a woman there are many things to consider, such as:

past experience of the woman

choices the woman has previously made

how much the woman already knows

what the woman would like to know

present choices the woman is currently needing to make

All in all, the language of birth should always be positive (even if an unexpected outcome occurs). Consider that any person that supports a woman during labour and birth (including doulas, midwives, obstetricians and others) can strongly drive how a woman copes with labour, how positive her experience is, how confident she will feel going into parenthood, and specific labour and birth outcomes, such as:

comfort during labour

feeling safe during labour

feeling supported during labour

length of labour

outcomes for the woman

outcomes for the baby

How then can the language of birth not be considered as a main concept of supporting women during such a cathartic time?

Talk to your support team during pregnancy to find out what they consider important when it comes to communicating with you at the birth of your baby.

Tuesday, February 24, 2009

I hear so many women ask if they are allowed to do something, particularly while in labour. I cringe inside at the sound of that phrase - "Am I allowed, really?"

Most women don't understand that what happens in labour is pretty negotiable. I always try to help women to remember that it is their body, their baby and their experience to protect.

For the most part, medical professionals (but usually midwives) are fairly accommodating to a woman's wishes - after all, she ishaving a baby; she is bringing a new life into the world; she will always remember this day... but, especially, she will always remember how she was treated.

Common questions I hear asked in terms of what a woman is "allowed" to do, include:

eat during labour (Why not?! Remember your body is doing some of the hardest work it will ever do, and you need to give it the energy needed to work effectively. Some hospitals [grr] are somewhat old-fashioned and prefer you not to eat should you require surgery, i.e. a c-section. Do your own research and find out there's absolutely no evidence to support that refraining from eating during labour is beneficial, in fact I would think it were on the contrare!)

move around during labour (There is much information on the positives of having an active labour and birth; specifically, a woman being able to take the position she feels is best will assist in keeping her as comfortable as possible, offer opportunities to get labour going or to provide the woman with some rest and allows the woman to use her intuition in adopting the best position to help baby move down through the pelvis and birth canal)

labour in the bath or shower (Even if the place where you are giving birth does not have a water birth policy, it is in the woman best interest to allow her to enter the bath or shower at any time she feels during her labour. There is specific information on labouring and birthing in water here.)

stay home as long as possible (There is actually evidence to support that staying home in labour while ever things remain 'uncomplicated' is beneficial. This is because you are generally more comfortable at home, less likely to get an infection if your membranes have ruptured, and [most importantly] you are less likely to feel as though you require the use of pain relief or intervention.)

There are many other questions about what a woman is "allowed or not allowed" to do. My general advice would be to discuss your options during pregnancy with your birth support team - this means the people that will be supporting you on the day, including the midwives in the birthing unit. They should be helpful on what their policies suggest a woman do during the birth of her baby.

Most midwives are very accommodating in allowing women the freedom to do what makes them feel best. This is because midwives primarily practice care that is woman-centred.

Go to the Australian College of Midwives website to read about the evidence that supports every woman being attended by a midwife during the birth of her baby. And remember that the choices you make BEFORE you have your baby will strongly determine how likely it will be that you are "allowed" to do what you wish during labour and birth.

Wednesday, February 18, 2009

Make Birth Yours is a series of informal meetings organised by the ACT Branch of Maternity Coalition.

As part of Maternity Coalition, Make Birth Yours is non-profit, non-political and non-sectarian.

The aim of Make Birth Yours meetings is to:

• encourage a woman-centred approach to the birth process;• support women in viewing pregnancy and childbirth as normal physiological processes, not illnesses; and• emphasise women's rights to make informed choices about their caregiver and place of birth.

Information on birth choices available in the ACT and surrounding area is made available at Make Birth Yours meetings.

Come and join us for an open, informal chat about how you can best prepare for a positive birth experience.

Tuesday, February 17, 2009

Thought I'd post an article here that I wrote for those accessing my website. It's a fabulously gorgeous article about what LOVE brings to pregnancy and giving birth.

A LABOUR OF LOVE

If there is one main theme that runs through giving birth to a baby, it is love.

While a baby is in the mother’s womb, it is a time when the she can begin to bond. When a mother talks to her baby whilst pregnant, she is feeling loving emotions that produce a response in her body that her baby can sense. Her baby will start to associate the happy voices he hears with the positive responses from his mother. And thus begins the bonding process.

It is not uncommon for a baby that is born into love to hold steady eye contact, immediately after the birth, with both his mother and father. The baby is studying the faces to whom those well-known voices belong and thus continues the bonding process, which began in the womb.

Babies who are carried and birthed in a loving and gentle atmosphere are often easy to spot. They are generally calm, contented babies that are very attentive from the moment they are born and become confident and adept toddlers.

Since a baby was meant to be conceived in love, it stands to reason that a mother who is lovingly supported during pregnancy and the birth of her baby will:

· feel more at ease emotionally· be able to cope better with changes during her pregnancy· be able to cope better with discomfort during the birth· be more confident in birthing the baby without unnecessary intervention· feel more confident in caring for the newborn

One of the best things you can do for your baby is to ensure you have loving care and support. This may be through your partner, through your friends and family, and through your doula. Your support people during labour should help to make you feel confident, safe and loved.

Help make the birth of your baby a "labour of love" by the choices you make before your baby arrives.

Sunday, February 15, 2009

It's funny how it comes on. Only about 2 months ago, Emily started getting alot more spunk in her personality. Emily is my 2-year-old (well, her birthday is next month). She has gotten alot more fond of making up her own mind (which is ok with some things, but not for others) and has worked out she can say no, and mean it.

Alas, to gently train a child in the ways she should go is harder than it seemed when she was small enough to be in the same place as I left her when I re-entered the room!!

I have found that the skill of being calm and positive during my pregnancy and Emily's birth has spread into my world as a parent. When Emily decides she'd like to do something her way, especially when it really isn't appropriate, I simply (ha ha) tell her "not right now" in a calm voice...

I'm a big believer in the saying: "if at first you don't succeed - try, try again". This can leave me saying things like, "Screaming is for danger" about 20 times a day, but after repeating this routine over Emily's 'screaming phase' (the past month) she has finally started to realise that unless she's in danger, we really would prefer that she doesn't scream! Same goes with the kick, yell and throw something when she can't manage to work it out - frustration. Emily has now worked out it takes much less energy to say "Help, please" and she knows that I will show her how it works and then let her have a try.

Oh, the joys of parenting a toddler! Let me just say that it is definitely well worth it, even on our worst days.

I've realised it is a journey for all of us, not a destination!! Parenting helps you deal with the worst of your traits, too.

Friday, February 13, 2009

I've just returned from the Baby and Kids Market - held about every 6 weeks at Woden CIT. It's a great place to meet other mums, grab yourself a bargain and learn about great services for mums (like doulas!).

Sunday, February 8, 2009

Why someone would want to light a fire and end so many lives is beyond me; I hope that they are caught and given fair punishment for such a hideous crime.

When you hear of such a tragedy, you know there are no words that will make anyone feel any better. I sincerely wish there were more I could do; I wish I could give hugs and tell them it will all turn out ok in the end. Instead, I will send up prayers and support those organisations that are helping out and donating goods.

For everyone's information, the up-coming Baby & Kids Market (http://www.babykidsmarket.com.au/) at Woden CIT on Saturday 14th February 2009 will be donating all left-over goods and part of the entry fee to those families most affected.

Keep all the families in your prayers and let's stick together in times of greatest need.

Saturday, February 7, 2009

This is a long story for a short but incredible experience – I wanted to capture all the details.

Just a short background note to get started – with my first child, I had a (ridiculously expensive!) obstetrician managed pregnancy through the private system. I had a nearly 24hr labour with lots of pain and anxiety (posterior baby), gas and an epidural. The end bit was very positive (45min second stage and got to “catch the baby” myself) but there were a few things I wanted different this time! Had no idea just how different it would be…

I was 9 days overdue and starting to get anxious about being pushed into an induction, as I was really keen and had been preparing for an intervention free natural birth. I had been reading Juju Sundin’s book “Birth Skills” and thought her techniques would work for me. The day before my “post dates appointment” I decided to try everything to get some action! I walked Ella the 2km round trip to daycare, my lovely doula Jen came and gave me a 1 ½ hr massage with some acupressure while I listed to Bach, and had a good long reassuring chat with me allaying my fears about a big baby, risks of going overdue, risks of induction etc. After she left I was all blissed out and decided to continue pressing the acupressure points every hour for the rest of the day. I had some spicy Mexican soup for lunch, and was having what I thought were quite strong Braxton hicks – they weren’t hurting but were intense enough for me to stop whatever I was doing at the time. I was having them every hour. That evening I told DP they were regular but I didn’t think they were prelabour as I hadn’t had a show or anything.

DP went to bed early that night and I was having to go to the toilet a lot (I thought it was probably just the spicy food!) and the tightenings were getting stronger. At 9pm I thought “well, I’ll go to bed, and if they’re just B-H they’ll go away when I lie down”. As soon as I lay down they got to 6 mins apart – but I was dozing in between so I thought “these aren’t strong enough for labour, must be prelabour”. Between 10 and 11 they were getting a bit uncomfortable to lie down for, and I thought “yep this is it, early labour” and got up to go to the toilet (again!). As soon as I got up they got to 3mins apart. But all I was doing to manage them was tap my thighs (if I was on the toilet) or count the leaves on the wallpaper to the beat of the Bach in my head! So I thought even though they were so close together, I must still be in early labour, as the contractions were still quite easy to manage.

At midnight I woke DP up, with no urgency, just thought he’d want to start getting things organized before we left. By this stage I was banging one fist into my other open hand, concentrating on the slap sound and visualizing either me running round the rugby field or saying in my head in time to the slaps “you can do this, you can do this”. I rang Jen at 1.30, and said I wasn’t sure if I should go in yet or not. I had to put the phone down for contractions by this stage. We decided Jen would start heading to the hospital now (it takes her longer to get there than me). I told DP to hurry up his packing of the car as I thought it was time to go. DP rang the birth suite who asked to talk to me, they asked how far apart the CX were and after hearing three minutes, said “wow - we’ll get a room ready for you”!

We loaded Ella into the car to take to her friend’s place (they were on standby for emergency babysitting!) and I started banging my stress balls onto the dashboard as I didn’t want my “smack” noise to scare Ella! Once we were on our way again, DP asked me to stop hitting the dash, as he was scared the airbags would go off, so I hit them on the door, and he said there are side airbags too! At this point I was in the middle of a contraction, and my concentration broke and I said “I’ve lost it” and got scared as for the first time I was flooded with pain. Then I thought “Juju said use another skill when one isn’t coping with the intensity any more” so I decided to use my voice and started breathing deeply then groaning out a deep, controlled “aaahhh” sound while I squeezed the stress balls.

I was hoping the adrenaline rush of being in the car would slow down labour but it didn’t seem to be working and I was afraid I wouldn’t make it to the hospital! I threw up once (fortunately I’d thought to tell DP to bring a bucket), I wonder if that was the start of transition. DP was wonderful, he was using this low calm but very encouraging voice, telling me what a great job I was doing and how proud he was and that we hadn’t much further to go. It was the longest 40 min trip in the world for both of us I think!

By the time we got to the hospital (2.30am), my groans were so loud they were vibrating in my ears (Juju again – she says match the activity to the pain, so step it up and get loud when you need to!) I was also back to my hand smacking which really seemed to work for me. Jen met us at the car – I said “I don’t think I can get out of the car” (!) but with help I did it. I had to stop walking for contractions. Jen said you could set a metronome to my hand slapping, it was so rythmic, and though I don’t remember it that I was rocking my hips too. They must have heard me upstairs because a man came down with a wheelchair. I REALLY did not want to sit down, but had the presence of mind to realize I needed to get to the birth suite fast! I still had to stop the chair and stand up for contractions though, as sitting still was impossible.

Jen was great for these contractions, as it was as close as I got to losing it. She would gently touch her hand to my shoulders if I was tensing up and I would notice that my groaning was turning into a more high pitched, worried sounding noise instead of the low, controlled one, so I could concentrate on “fixing” the noise and that got me back in the zone!

We got to the birth suite and they took the usual measurements, which was hard as I needed both hands for my smacking!! The contractions were very close. They asked me what I wanted to do and I said “I don’t know” (I remember feeling really confused at this point – shouldn’t I know what to do?) I ended up asking for the toilet, as I had spent so much time there earlier and I thought sitting might give me a rest. As soon as I stepped into the bathroom I said “I feel like something’s about to fall out!” so they asked to do an internal- which broke my waters with a massive gush! There was meconium in the waters and I could hear the midwife calling for assistance in the background. I was 8cm then. I sat on the toilet and said – “Oh my God I need to push!” The midwives were very encouraging and said push if you need to – but then they asked me to lie on the bed so they could put on a foetal monitor (the heartbeat was fine by the way!) I really was not keen on that idea but oh well –part of my brain that was still working (yippee no drugs!) told me to throw an arm around DP and a midwife, and say briskly “come on then, let’s get this done”. So up on the bed and pushing with each contraction – but then they told me to stop pushing, as I had an anterior lip and needed to wait until it retracted to push. That was absolutely the hardest thing – not pushing when your body is screaming at you to do it! I couldn’t stop my body a couple of times so I just held back and didn’t put any effort behind the push. DP was such a strength to me – I was gripping his arm and he was gripping me right back, giving me such support. Finally (seemed like forever!) the midwife was able to push the lip back and I could push again. They said “here’s the head” and I yelled “I can feel it!” with a big grin on my face… that feeling of imminent relief and excitement is indescribable – and she shot out! They said “stop pushing now” (the cord was around the neck once) but it was too late, she was coming no matter what. It was 3.05am – half an hour after we’d arrived!

For a couple of seconds they were checking her breathing etc (her APGAR's were perfect), and I was saying “give her to me, give her to me” and then there she was, on my tummy, looking up at me calmly with big dark eyes. What a rush – having no drugs this time meant I was totally “there” for the whole birth, and it made such a difference to how I felt afterwards. All the staff left the room and I gave her a bit of guidance to her first feed – she fed beautifully and went right off to sleep.

So I got my natural birth this time, and what an amazing experience. After anticipating another long labour, it was 5 ½ hrs from start to finish! I felt like I owned the whole thing – even when it was really powerful and full on, it was like feeling a massive surge of a wave which I didn’t control, but was riding on top of the whole time without being afraid. I had no stitches, and was home again a day and a half later ( I chose to stay in hospital overnight to get some rest before going home to Ella!) and after that extraordinary ride, I feel so empowered and strong – if I can do that, what can’t I do?

The things I think made the most difference were: going through the public system – the whole pregnancy I felt I was treated more with the assumption that nothing would go wrong; using the Birth Skills – that book is amazing and worked so well for me; and having a doula – you can’t put a price on having someone (who has seen a lot of births) telling you all along that you’ll do great, and having strategies to deal with anything that comes along – just having faith in you and instilling faith in yourself.

And don't you realise how much you love your DP when you go through something that intense as a team?

Rachael is a lovely baby- feeds well, self settles, smiles all the time – and I wonder how much of it had to do with our amazing birth experience together.

***************************************

Wow! What a fantastic account of an amazing experience! Thanks to Bec for sharing with all of us. :)

Friday, February 6, 2009

I start in just 3 days and feel like it's my first day at big school...

I know, I know. I hear you all say, "You've seen births, you love it and it inspires you, so what's the problem??!" To which I say, "Hmmm... No problem, just pre-course jitters I guess!"

I love the fact that I am going to learn so much more about supporting women who are "with child". I feel blessed that I've had the opportunity to work with women as a doula, in a capacity that has eased me into the world of birthing and has allowed me the chance to see how birth CAN BE. I do believe there would be more opportunities for me to become cynical about the fact that BIRTH DOES WORK if I were first thrust into a medicalised environment.

Here's the deal... I want you to help me stay accountable to lovely birthing women everywhere! Therefore, I openly give you permission to slap me if I ever:

Fail to promote birth as a normal, physiological process that is NOT an emergency waiting to happen;

Fail to promote primary midwifery care as the best way to offer maternity care everywhere (even though an obstetrician may be present at some stage);

Followers

About Me

My name is Jen. I am married to a loving, caring and supportive man and we have 3 wonderfully gorgeous daughters, aged 5 years, 2 years and 6 months. I believe that God has blessed me and continues to do so as I journey life. I am a certified birth & postnatal doula and enjoy watching women become empowered during the experience of pregnancy, birth and being a mum.